AxSpa Treatment Goals and Windows of Opportunity

Hillary Norton, MD, considers the windows of opportunity in managing axial spondyloarthritis to prevent various comorbidities and discusses the goals of therapy.

Hillary Norton, MD: The goals of therapy are to minimize the symptoms, to maintain function, to minimize extra-articular complications, and to minimize complications of spinal disease.

The goals of therapy do vary from patient to patient and are very personal. Many patients are athletes and want to continue to perform at a high level. Other patients have different personal goals, but maintenance of function and decrease in pain are shared goals among all patients.

The ASDAS [ankylosing spondylitis disease activity score] is a composite disease severity index that is used primarily in clinical trials to assess disease activity. And it looks at factors such as back pain, stiffness, and patient global and inflammatory markers such as ESR [erythrocyte sedimentation rate] and CRP [C-reactive protein].

The ASDAS measure is primarily used for research. In the clinic, we have some other outcome measures that may be used, such as the BASDAI [Bath ankylosing spondylitis disease activity index], which can assess disease severity so that we can assess how a patient is doing.

Early diagnosis of axSpA is very important primarily for quality of life for the patient. This prevents unnecessary medical costs and unnecessary invasive procedures if a correct diagnosis is made. Additionally, we can treat the root of the disease instead of just treating the pain.

An active area of research right now is whether nonradiographic axSpA will always progress to AS [ankylosing spondylitis]. And this is still unknown. We do think that early treatment of nonradiographic axSpA may prevent many of the complications of disease, and we are increasingly getting data that tell us that this may prevent nonradiographic disease from progressing. But the answers to this are not entirely known yet.

There are factors that can increase the risk of progression from nonradiographic disease to AS, including early syndesmophytes seen in the spine as well as male gender.